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Treatment of Refractory Osteosarcoma With Fractionated Cyclophosphamide and Etoposide
Abstract
PURPOSE: Standard multiagent chemotherapy for osteosarcoma may include platinum compounds, doxorubicin, and high-dose methotrexate. By identifying new chemotherapeutic strategies, the outcome of these patients can be improved and the toxicity of treatment regimens decreased. PATIENTS AND METHODS: The authors evaluated the activity of the combination of cyclophosphamide (500 mg/m2 per day for 5 days) and etoposide (100 mg/m2 per day for 5 days) given with granulocyte colony-stimulating factor (G-CSF) to children with osteosarcoma unresponsive to conventional treatment. RESULTS: Fourteen patients with refractory osteosarcoma were treated with this combination. Twelve patients had been previously treated with a multiagent regimen that included carboplatin, ifosfamide, methotrexate, and doxorubicin. Seven of 11 evaluable patients had a poor histologic response in their primary tumor at the time of definitive surgery (Huvos grade 1 or 2). Sites of relapse included lung, bone, and brain. A total of 47 courses were given. An overall response rate of 28.5% was achieved. A complete response was obtained in one patient (7.1%), a partial response was obtained in three patients (21.4%), and stable disease for 1 to 4 months was achieved in five patients (35.7%). Five patients (35.7%) had progressive disease. Grade 4 neutropenia was the primary form of toxicity observed; the median duration of absolute neurophil count less than 500/microL was 4 days. CONCLUSIONS: The combination of cyclophosphamide and etoposide resulted in a response rate of 28.5% in patients with refractory or relapsed osteosarcoma, and its incorporation into front-line therapies deserves further evaluation.
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“One study suggests that fractionated cyclophosphamide can replace ifosfamide, with similar response rates 145 .”
From Osteosarcoma (2022) · cites this paper as [145]
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Self-citation
Metadata
- Authors
- Rodríguez-Galindo, C., Daw, N. C., Kaste, S. C., Meyer, W. H., Dome, J. S., Pappo, A. S., Rao, B. N., & Pratt, C. B.
- Affiliations
- St. Jude Children's Research Hospital (US)
- Venue
- Journal of Pediatric Hematology/Oncology
- Published
- 2002-05
- Volume
- 24
- Issue
- 4
- Pages
- 250-255
- ISSN
- 1077-4114 (ISSN-L)
- OpenAlex
- W2073867312
- Cited by
- 40
- References
- 52
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2016: 1 · 2015: 2 · 2014: 4 · 2012: 3
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Hematology/Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA-23099, P01CA023099, P 30CA 21765, P30CA021765)
- Topics
- Health Sciences › Medicine › Oncology › Sarcoma Diagnosis and Treatment
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone Tumor Diagnosis and Treatments
- Health Sciences › Medicine › Hematology › Acute Lymphoblastic Leukemia research
- Keywords
- relapsed osteosarcoma, cyclophosphamide, etoposide, fractionated chemotherapy, granulocyte colony-stimulating factor, pediatric osteosarcoma, neutropenia, treatment toxicity, combination chemotherapy
- MeSH terms
- Adolescent, Antineoplastic Combined Chemotherapy Protocols, Bone Neoplasms, Child, Cyclophosphamide, Dose-Response Relationship, Drug, Etoposide, Female, Humans, Male, Neoplasm Recurrence, Local, Retrospective Studies, Osteosarcoma, Survival Rate, Treatment Outcome
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